ATI pediatrics proctored exam

Chapter 1: Family centered nursing care

1. Parenting styles

-Dictatorial or authoritarian:

-Parents try to control the child’s behaviors and attitudes through

unquestioned rules and expectations

-Ex: The child is never allowed to watch television on school nights

-Permissive:

-Parents exert little or no control over the child’s behaviors, and consult the

child when making decisions

-Ex: The child assists with deciding whether he will watch television

-Democratic or authoritative:

-Parents direct the child’s behavior by setting rules and explaining the reason

for each rule setting

-Ex: The child can watch television for 1 hr on school nights after

completing all of his homework and chores

-Parents negatively reinforce deviations form the rules

-Ex: The privilege is taken away but later reinstated based on new

guidelines

Chapter 2: Physical assessment findings

1. Vital signs

-Usually vital signs are all high except for BP

-Temperature:

-3 – 6 months 99.5

-1 year 99.9

-3 year 99.0

-5 years 98.6

-7 years 98.2

-9 – 11 years 98.1

-13 years 97.9

-Pulse:

-Newborn 80 – 180/min

-1 weeks – 3 months 80 – 220/min

-3 months – 2 years 70 – 150/min

-2 – 10 years 60 – 110/min

-10 years and older 50 – 90/min

-Respirations:

-Newborn – 1year 30 – 35/min

-1 – 2 years 25 – 30/min

-2 – 6 years 21 – 25/min

-6 – 12 years 19 – 21/min

-12 years and older 16 – 19/min

-Blood pressure:

-Low as a baby but increases the older they get

-Infants:

-Systolic: 65-78

-Diastolic: 41-52

2. Head

-Fontanels should be flat

-Posterior fontanel:

-Closes by 6-8 weeks

-Anterior fontanel:

-Closes by 12-18 months

3. Teeth

-Infants should have 6-8 teeth by 1 year old

-Children and adolescents should have teeth that are white and smooth, and begin

replacing the 20 deciduous teeth with 32 permanent teeth

4. Infant Reflexes

Stepping Birth to 4 weeks

Palmar Grasp Birth to 3 months

Tonic Neck Reflex (Fencer Position) Birth to 3 – 4 months

Sucking and Rooting Reflex Birth to 4 months

Moro Reflex (Fall backward) Birth to 4 months

Startle Reflex (Loud Noise) Birth to 4 months

Plantar Reflex Birth to 8 months

Babinski Reflex Birth to 1 year

Chapter 3: Health promotion of infants (2 days to 1 year)

1. Physical Development

-Weight:

-Doubled by 5 months

-Tripled by 12 months

-Quartered by 30 months

-Height:

-2.5 cm (1 in) per month for the first 6 months

-Length:

-Increases by 50% by 12 months

-Dentition:

-First teeth erupt between 6-10 months

2. Motor skill development

 1 Month

o Head lag

o Strong grasp reflex

 2 Months

o Lifts head when prone

o Holds hand in open position | Grasp reflex fades

 3 Months

o Raises head and shoulders when prone | Slight head lag

o No grasp reflex | Keeps hands loosely open

 4 Months

o Rolls from back to side

o Grasp objects with both hands

 5 Months

o Rolls from front to back

o Palmar grasp dominantly

 6 Months

o Rolls from back to front

o Holds bottle

 7 Months

o Bears full weight on feet | Sits, leaning forward on both hands

o Moves objects from hand to hand

 8 Months

o Sits unsupported

o Pincer grasp

 9 Months

o Pulls to a standing position | Creeps on hands and knees instead of crawling

o Crude pincer grasp | Dominant hand is evident

 10 Months

o Prone to sitting position

o Grasps rattle by its handle

 11 Months

o Walks while holding onto something | Walks with one hand held

o Places objects into a container | Neat pincer grasp

 12 Months

o Stands without support briefly | Sits from standing position without assistance

o Tries to build a two-block tower w/o success | Can turn pages in a book

3. Cognitive development

-Piaget: sensorimotor (birth to 24 months)

-Object Permanence: objects still exists when it is out of view

-Occurs at 9-10 months

4. Language development

-3-5 words by the age of 1 year

5. Psychosocial development

-Erikson: Trust vs. Mistrust:

- Learn delayed gratification

-Trust is developed by meeting comfort, feeding, simulation, and caring

needs

-Mistrust develops if needs are inadequately or inconsistently met or if needs

are continuously met before being vocalized by the infant

6. Social development

-Separation Anxiety: protest when separated from parents

-Begins around 4-8 months

-Stranger Fear: ability to discriminate between familiar and unfamiliar people

-Begins 6-8 months

7. Age appropriate activities

-Rattles

-Playing pat-a cake

-Brightly colored toys

-Playing with blocks

8. Nutrition

-Breastfeeding provides a complete diet for infants during the first 6 months

-Solids are introduced around 4-6 months

-Iron-fortified cereal is the first to be introduced

-New foods should be introduced one at a time, over a 5-7 day period to

observe for allergy reactions

-Juice and water usually not needed for 1st year

-Appropriate finger foods:

-Ripe bananas

-Toast strips

-Graham crackers

-Cheese cubes

-Noodles

-Firmly cooked vegetables

-Raw pieces of fruit (except grapes)

9. Injury prevention

-Avoid small objects (grapes, coins, and candy)

-Handles of pots and pans should be kept turned to the back of the stove

-Sunscreen should be used when infants are exposed to the sun

-Infants and toddlers remain in a rear-facing car seat until age 2

-Crib slats should be no farther apart than 6 months

-Pillows should be kept out of the crib

-Infants should be placed on their backs for sleep

Chapter 4: Health Promotion of Toddlers (1 to 3 years)

1. Physical development

-Weight:

-30 months: 4 times the birth weight

-Height:

-Toddlers grow 7.5 cm (3 in) per year

-Head circumference and chest circumference:

-Usually equal by 1 to 2 years of age

2. Cognitive development

-Piaget: sensorimotor stage transitions to preoperational stage 19 – 24 months

-Object Permanence: fully developed

3. Language development

-1 year: using one-word sentences

-2 years: 300 words, multiword sentences by combining 2-3 words

4. Psychosocial Development

-Autonomy vs. Shame and Doubt

-Independence is paramount for toddlers who are attempting to do

everything for themselves

-Use negativism or negative responses to express their independence

-Ritualism, or maintaining routines and reliability, provides a sense of

comfort for toddlers as they begin to explore the environment beyond those

most familiar to them

5. Age appropriate activities

-Parallel play: Toddlers observe other children and then might engage in activities

nearby

-Appropriate activities:

-Playing with blocks

-Push-pull toys

-Large-piece puzzles

-Thick crayons

-Toilet training can begin when toddlers have the sensation of needing to urinate or

defecate

6. Motor skill development

 15 Months

o Walks without help | Creeps up stairs

o Uses a cup well | Builds 2 tower blocks

 18 Months

o Runs clumsily | Throws overhand | Jumps in place w/ both feet | Pulls/Pushes

toys

o Manages a spoon w/o rotation | Turns pages 2-3 pages /time | Builds 3-4

blocks | Uses crayon to scribble spontaneously | Feeds self

 24 Months (2 years)

o Walks backwards | Walks up/down stairs w/ 2 feet on each step

o Builds 6-7 blocks | Turns pages 1 @ a time

 30 Months (2.5 years)

o Balances on 1 leg | Jumps across floor / off chair w/ both feet | Walks tiptoe

o Draws circles | has good hand-finger coordination

7. Nutrition

-Whole milk at 1 year old

-Can start drinking low-fat milk after 2 years of age

-Juice consumption should be limited to 4-6 oz. per day

-Foods that are potential choking hazards:

-Nuts

-Grapes

-Hot dogs

-Peanut butter

-Raw carrots

-Tough meats

-Popcorn

Chapter 5: Health Promotion of Preschoolers (3-6 years)

1. Physical development

-Weight:

-Gain 2-3 kg (4.5-6.5 lb) per year

-Height:

-Should grow 6.9-9 cm per year

2. Fine and gross motor skills

 3 Years

o Toe and heel walks

o Tricycle

o Jumps off bottom step

o Stands on one foot for a few seconds

 4 Years

o Hops on one foot | Skips

o Throws ball overhead

o Catches ball reliably

 5 Years

o Jumps rope

o Walks backward

o Throws and catches a ball

3. Cognitive development

-Piaget: preoperational stage

-Moves from totally egocentric thoughts to social awareness and the ability

to consider the viewpoint of others

-Magical thinking:

-Thoughts are all-powerful and can cause events to occur

-Animism:

-Ascribing life-like qualities to inanimate objects

4. Psychosocial development

-Erikson: Initiative vs. guilt:

-Preschoolers become energetic learners, despite not having all of the

physical abilities necessary to be successful at everything

-Guilt can occur when preschoolers believe they have misbehaved or when

they are unable to accomplish a task

-During stress, insecurity, or illness, preschoolers can regress to previous immature

behaviors or develop habits (nose picking, bed-wetting, thumb sucking)

5. Age appropriate activities

-Preschooler’s transition to associative play

-Play is not highly organized, but cooperation does exist between children

-Appropriate activities:

-Playing ball

-Putting puzzles together

-Riding tricycles

-Playing pretend dress up activities

-Role-playing